Background Parkinsonism is strongly associated with ageing, and many studies have suggested that parkinsonian signs may affect up to half of older adults and is associated with a wide range of adverse health outcomes. We compared clinical and functional characteristics of oldest-old community-dwelling individuals with parkinsonism (parkinsonian group [PG]) to individuals without parkinsonism (non-parkinsonian group [NPG]. Methods The Pietà study is a population-based study conducted in Caeté, southeast Brazil, involving 607 individuals aged 75 + years submitted to an extensive clinical evaluation. A subset of 65 PG individuals (61.5% women, median age of 82 years) was compared to 542 NPG individuals (64.8% women, median age of 80 years). Results PG individuals had significantly more functional impairment, clinical comorbidities (including number of falls, loss of bladder control and dysphagia) and major depression. Multivariate analysis revealed that older age, higher UPDRSm scores, lower category fluency test (animals/minute) and delayed recall memory scores were associated with PG. This group was also more cognitively impaired, with lower performance than NPG individuals in the Mini-Mental State Examination, category fluency test (animals/minute), clock drawing and in delayed recall (p < 0.001 for all tests). UPDRSm scores were the most contributing factor to cognition that independently explained variability in functionality of the entire sample. Conclusion Individuals aged 75 + years with parkinsonism were significantly more clinically and functionally impaired in this population-based sample. Cognitive dysfunction explained most of the loss of functionality in these patients. UPDRS-m scores contributed independently to explain variability in functionality in the whole sample.

Background: Delirium subsyndrome (SSD) and delirium (DL) are known complications in the intensive care unit (ICU) and are associated with worse clinical outcomes. The aim of this study was to screen for SSD and DL in individuals with COVID-19 admitted to the ICU and to study the associated factors and clinical outcomes. Method: An observational, longitudinal study was conducted in the reference ICU for COVID-19. All admitted individuals with COVID-19 were screened for SSD and DL during their ICU stay using the Intensive Care Delirium Screening Checklist (ICDSC). Individuals with SSD and/or DL were compared to those without SSD and/or DL. Results: Ninety-three patients were evaluated, of which 46.7% had SSD and/or DL. The incidence rate was 4.17 cases/100 person-days. Individuals with SSD and/or DL had higher severity of illness on admission to the ICU, as measured by the APACHE II score (median 16 versus 8 points, p < 0.001). SSD and/or DL were associated with longer ICU and hospital stays (median 19 versus 6 days, p < 0.001 and median 22 versus 7 days, p < 0.001, respectively). Conclusion: Individuals with SSD and/or DL had greater disease severity and longer ICU and hospital stays when compared to those without SSD and/or DL. This reinforces the importance of screening for consciousness disorders in the ICU.

IntroductionMigraine, is one of the most prevalent types of headaches, affects around 15% of people worldwide, more common among women, and causes a great effect in the quality of life of the individual. The diagnosis criteria of this disease is due to its duration and other characteristics such as phonophobia, photophobia, unilateral, pulsatile and intense crisis, nausea and vomiting, which can be preceded by aura and premonitory symptoms. With the purpose to ease those symptoms, the patients have a drug overuse. The medication-overuse headache (MOH) is an emerging problem, due to the possibility of developing psychiatric disorders like obsessive compulsive disorder (OCD) and impulsivity. Impulsivity consists in actions where the individual does not reflect upon it and make decisions fast, without planning or analyzing the case in the long term. Compulsion is defined as repetitive actions with the intention to ease anxiety or an uncomfortable situation. ObjectiveDetermine a prevalence of OCD in migraine patients, evaluating different scopes of it, including the association or not with drug abuse. MethodsA cross-sectional study with 117 patients of both sexes, older than 18 years old. The group was made with migraine patients diagnosed by a neurologist according to the International Classification of Headache Disorders (ICHD) separated in two groups, one that has analgesics abuse and other that do not have. Three questionnaires were used: Barratt Impulsiveness Scale (BIS-11); Obsessive Compulsive Inventory-Revised (OCI-R) and the Migraine Disability Assessment (MIDAS). The data collected was placed in an electronic worksheet and processed in Software SPSS Statistics 22.0. There was an assumption of a p value of 0,05 to all cases with the intention to reject the null hypothesis. (To see the complete abstract, please, check out the PDF).

Resumo Introdução A tuberculose, caracterizada pela Organização Mundial de Saúde (OMS) como emergência sanitária mundial, é uma doença de impacto global. Objetivo Realizar série histórica de casos de tuberculose em um período de 17 anos em Ouro Preto, Minas Gerais, considerando a histórica relação da doença com a mineração. Método Dados foram obtidos em sistema próprio de registros do município, por busca ativa em prontuários médicos e comparados à quantidade de casos notificados no Sistema de Informação de Agravos de Notificação (SINAN). Para análises de tendência, foram utilizados modelos de regressão polinomial para séries históricas. Resultados Idade média dos casos foi 40,3 ± 16,4 anos. Homens apresentaram 2,23 vezes mais casos e chance 2,07 vezes maior para desfechos negativos. A forma mais observada foi pulmonar (84%), e sorologia para HIV foi realizada em apenas 16,3% dos registros. Principal desfecho observado foi cura (70%), e desfechos negativos totalizaram 20,2% dos registros. Taxa de incidência média foi 29,76 e 16,23 casos/100 mil habitantes na área municipal e distrital, respectivamente. Conclusão Apesar da relação histórica entre mineração e tuberculose no município, observa-se que este ainda apresenta preocupantes vulnerabilidades em relação à vigilância da doença. Análise de série temporal sugeriu declínio na proporção de casos curados entre 2009 e 2015.

Context: COVID19 has better known respiratory impacts than cardiovascular1 and high D-dimer as the most significant coagulation parameter2 . Otherwise, paradoxical embolism due to Patent Foramen Ovale (PFO) and Ischaemic Cerebral Vascular Accident (iCVA) mechanisms associated are poorly documented3, 4 . We aimed to report an associated case of iCVA and PFO and highlight COVID19 hypercoagulability triggering thromboembolisms. Case report: CTT, 76y, female, hypertensive, former-smoker was hospitalized with right-hemiplegia, transcortical aphasia, dysarthria by iCVA and evolved with headache, odynophagia, fever, chills. RT-PCR-SARS-Cov2: positive; chestCT: 25% bilateral pulmonary involvement, ground-glass opacities. 8days later, was transferred to ICU-COVID-HU-UFJF; D-dimer=827. In 30days, went to ward with O2-dependent pulmonary sequelae; CT-angiography excluded Pulmonary Thromboembolism. Searched iCVA mechanism, ECO detected PFO=2.8mm and Interatrial Septum aneurysm. Prescribed anticoagulants. Subsequently, presented right-clonus, further previous RankinScale=5. Requested brain-MRI pointed lobar hemorrhage with mass effect in recent iCVA’s territory (left-Middle Cerebral Artery). After 10days, a head-CT evidenced partial resorption and reduced mass effect. Patient was discharged taking rivaroxabana. Conclusions: Retrospectively, we suspected that COVID19 hypercoagulability triggered Deep Vein Thrombosis and the consequent PFO paradoxical embolism, which caused iCVA. Therefore, vascular pathologies in COVID19 deserve further studies. Treatment for secondary prevention in iCVA by PFO is uncertain3 .

Background: Headache is the most frequent neurological complaint in the population and the group of tension-type headaches (TTH) is the most prevalent subtype. Nevertheless, more information about the clinical features of headaches in patients attended at specialized centers are demanded. Methods: Cross-sectional, descriptive study. Data from patients referred to an outpatient specialized headache center from 2018 to 2019 were analyzed and clinical and epidemiological information was collected. This study was authorized by the research ethics committee of the HUUFJF (CAAE 03530818.9.0000.5133). Results: Data from 153 patients were assessed. The mean age of patients was 45,6 years and most cases were women (80,4%). The most frequent diagnosis were migraine (49,7%), TTH (22,8%) and temporomandibular disorders (8,5%). The prevalence of chronic headaches was 46,6%. Analgesic abuse was identified in 32% of participants, with a higher prevalence in women (Fischer’s exact test, P=0,05). Prophylactic treatment was used by 84,3% of the subjects. Pain was self-reported mild in 21,6% of cases, moderate in 30,1% and severe in 47,1%. The pain severity was inversely proportional to age (P=0,012). The most frequent associated symptoms were photophobia (57,5%), phonophobia (56,9%), nausea/ vomiting (47,1%). Conclusions: The findings show important differences in the prevalence of headache cases in specialized centers compared to the general population. Given the high prevalence of analgesic abuse reported, the development of effective educational programs for patients and healthcare providers at primary and secondary health services, might reduce the social burden of chronic headaches and decrease the demand for consultations on specialized headache clinics.

BackgroundHeadache is a common symptom that affects a significant portion of the general population. It constitutes a challenge for diagnosis in urgency and emergency care services, due to headache’s clinical variability and diverse possible etiologies, besides the limited time and resources of these facilities. Because of this insufficiency and the potential severity associated with the condition, headaches generate considerable expenditures to health systems, related to both diagnostic discrimination and treatment.ObjectiveEvaluating the diagnostic resources used on headache patients care, as well as its Public Health Relevanceand relation to cost in an Emergency and Urgency Care unit.MethodsCross-section study analyzing 450 medical records of patients with headache complaints in the time frame from January 1, 2019, and December 31, 2019. Patients were categorized according to the type of headache (primary and secondary), specialized evaluation, complementary exams used in the diagnosis, hospital observation time, and the final expenditure in each patient’s care.ResultsThe total estimated expenditures related to headache care equaled US$90,855.60 (average US$201.90 per patient). 38.9% of cases corresponded to primary headaches and 31.1% to secondary headaches. 30% of cases could not be classified. The resources utilized for secondary headaches diagnosis differed significantly from those used in primary headache diagnosis. However, the final expenditures were similar to both groups.ConclusionThe socio-economic impact caused by headaches is unquestionable. It is a highly frequent symptom and both its etiological distinction and adequate treatment require solid evaluation. Due to the resources spent in its evaluation and monitoring, headaches can be considered a public health problem. Therefore, this study suggests that resources should be allocated in the health education and professional training for the proper conduction of these patients, so that they may benefit from an optimized treatment of theircondition without overwhelming the health system.

Resumo Pênfigo compreende grupo de doenças bolhosas autoimunes que possuem tendência à progressão, com evolução ilimitada e crônica e com prognóstico potencialmente fatal. O tipo mais comum é o Pênfigo Foliáceo Endêmico (PFE), caracterizado pela presença de lesões cutâneas com formação de bolhas na face, no couro cabeludo e na região interescapular. Fatores de ordem ambiental, genéticos e imunológicos podem desencadear a enfermidade. Entre os fatores ambientais, exposição a mercúrio, poeiras minerais e a picada do mosquito Simulium nigrimanum devem ser considerados. Buscou-se, neste artigo, relatar a ocorrência do PFE entre a população de Antônio Pereira, distrito rural de Ouro Preto, Minas Gerais, bem como identificar possíveis associações da doença com fatores ocupacionais e ambientais locais. Foi constatada uma prevalência de 4,57 casos de PFE/1.000 habitantes, considerada bastante elevada. Observou-se associação estatística entre a doença e contato com barragem de rejeitos de mineração (p = 0,048) e exposição ao mercúrio (p = 0,008). Os resultados indicam a necessidade de vigilância epidemiológica eficaz das comunidades afetadas, assim como adequada assistência à saúde dos pacientes acometidos pela doença.

Thiamine is a water-soluble vitamin, essential for normal cellular functions and energy production. As it is not synthesized by the human organism, it must be obtained by exogenous sources. A reduction in thiamine tissue concentration may interfere with numerous cellular mechanisms triggering off neurodegenerative processes with consequent changes in brain functions. Thiamine deficiency is common in certain groups like alcohol chronic users, pregnant woman, and people living in food insecurity situation. The low offer of thiamine for newborn and infants can compromise the correct maturation of the central nervous system and development of the cognition as explained by animal models studies. Thiamine deficiency during pregnancy and breastfeeding induces dysfunctions in the learning and consolidation of spatial abilities of offspring that can compromise the access of children living in food insecurity situations to formal job and education. Observed from this perspective, thiamine deficiency in vulnerable populations plays a more important role than the manifestation of clinical syndromes: the thiamine deficiency can be understood as a mechanism for perpetuating the poverty condition. Based on favorable risk/benefit profile, we recommend the fortification of easily accessible foods (such as wheat flour) with thiamine and oral replacement for alcohol dependent people, pregnant women, and infants living in situations of food insecurity.